Do children without a known bleeding tendency undergoing PICC placement require coagulation laboratory testing?
| Autor: | Leonardo R. Brandão, Joel Woodley-Cook, Joao G. Amaral, Bairbre Connolly |
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| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Adolescent business.industry Infant Newborn Infant Central venous line Blood Coagulation Disorders Laboratory testing Peripherally inserted central catheter Surgery Venous access Risk Factors Child Preschool Anesthesia Catheterization Peripheral Pediatrics Perinatology and Child Health Humans Medicine Female Radiology Nuclear Medicine and imaging Child business Retrospective Studies |
| Zdroj: | Pediatric Radiology. 45:727-735 |
| ISSN: | 1432-1998 0301-0449 |
| DOI: | 10.1007/s00247-014-3207-6 |
| Popis: | Obtaining basic hemostatic laboratory investigations prior to peripherally inserted central catheter (PICC) insertion remains controversial, even if the procedure is converted to a tunneled central venous line (CVL) placement.To determine the value of pre-procedural blood screening (hemoglobin level, platelet count, aPTT/INR) in hospitalized children without a known bleeding diathesis.This retrospective review included pediatric patients undergoing PICC insertion who had both laboratory screening and post-PICC hemoglobin level. Two cohorts (A: 0-3 months; B:3 months-18 years) were analyzed for procedural major/minor bleeding.Of 1,441 consecutive children identified during a 3-year period, 832 patients (226 in cohort A, 606 in cohort B) fulfilled the inclusion criteria. Overall, 36% (300/832) of the patients had at least one abnormal laboratory result. Only 0.2% (3/1,441) of patients required conversion to a central venous line. In cohort A no major bleeding occurred; the minor bleeding frequency was 30% (68/226). Neither abnormal laboratory results nor correction of abnormal laboratory results was associated with minor bleeding complications. The positive and negative predictive values (PPV/NPV) of having abnormal laboratory screening were 0.22 and 0.68, respectively. In cohort B the major bleeding frequency was 1% (6/606) but no patient required any blood transfusion; minor bleeding occurred in 29% (174/606). Neither abnormal laboratory results nor correction of abnormal laboratory results was associated with minor bleeding complications. The PPV and NPV of abnormal laboratory screening results were 0.24 and 0.72, respectively.Pre-procedural blood screening did not predict bleeding in hospitalized children without a known bleeding diathesis undergoing PICC insertion. The rarity of major bleeding complications and need for conversion to a central venous line did not support a need for laboratory screening. |
| Databáze: | OpenAIRE |
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